| NPI | 1083895379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C153827) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 246293) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX M7985) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2022-11-16 |